Rituximab for Recurrence of Primary Focal Segmental Glomerulosclerosis After Kidney Transplantation: Clinical Outcomes

Garrouste, Cyril; Canaud, Guillaume; Büchler, Mathias; Rivalan, Joseph; Colosio, Charlotte; Martinez, Frank; Aniort, Julien; Dudreuilh, Caroline; Pereira, Bruno; Caillard, Sophie; Philipponnet, Carole; Anglicheau, Dany; Heng, Anne Elisabeth

doi:10.1097/tp.0000000000001160

Cited by 63 publications

(56 citation statements)

References 44 publications

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“…Randomized controlled trials are lacking, and disease definitions, treatment regimens, and definitions of response to therapy vary greatly. Therapeutic strategies consist of methylprednisolone, high‐dose cyclosporine, cyclophosphamide, PF, plasma filtration, IA, LDL‐apheresis, IVIG, R, and ofatumumab . In this study, we investigated local preventive and/or therapeutic policies of recurrent FSGS after renal transplantation through a survey sent to all members of the ESPN.…”

Section: Introductionmentioning

confidence: 99%

European Society of Pediatric Nephrology survey on current practice regarding recurrent focal segmental glomerulosclerosis after pediatric kidney transplantation

Bouts

Veltkamp

Tönshoff

et al. 2019

Pediatric Transplantation

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Introduction Primary FSGS is an important cause of ESRD in children. FSGS recurrence after kidney transplantation is associated with early graft loss. No guidelines for treatment of FSGS recurrence exist. We conducted a survey to gain insight into variation of treatment between centers. Methods A survey was sent to all members of the ESPN on behalf of the “Renal Transplantation” and “Idiopathic Nephrotic Syndrome” working groups. Results Fifty‐nine nephrologists from 31 countries responded, reporting 807 FSGS patients, with 241 (30%) FSGS recurrences after transplantation. Recurrence varied from 0% to 100% between respondents. Native nephrectomy before or during transplantation was performed, respectively, always (37%), never (39%), or on clinical indication (17%). Half of the respondents started preventive treatment before transplantation, using PF (n = 10); R (n = 4); PF or IA, plus R (n = 9); cyclosporine (n = 2); or unknown (n = 4). Immunosuppressive therapy for patients without known mutations consisted of a combination of steroids, tacrolimus/cyclosporine, and MMF, with or without IL‐2R‐blockade in, respectively, 61% and 86% of the respondents. Sixty‐three percent applied a similar regimen to patients with known mutations. FSGS recurrence was treated with PF or IA, plus R by 66% of respondents; 54% observed no response. Complete remission in >50% of patients was reported by 41% of the respondents. Discussion FSGS recurrence after transplantation is common, but varies greatly between centers. We found great variability in preventive and therapeutic treatment regimens. Future research should focus on predisposing factors, including biopsy findings and genetic mutations, and standardized treatment.

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Section: Introductionmentioning

confidence: 99%

European Society of Pediatric Nephrology survey on current practice regarding recurrent focal segmental glomerulosclerosis after pediatric kidney transplantation

Bouts

Veltkamp

Tönshoff

et al. 2019

Pediatric Transplantation

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“…In addition, its efficacy in some cases supports the hypothesis that B lymphocytes are involved in certain forms of FSGS through the production of some antibodies [16]. A recent study has described that its administration appears to be particularly useful for patients in whom conventional treatment with plasma exchange, steroids and calcineurin inhibitors has failed because it obtains a 50% remission rate in these cases [17]. …”

Section: Discussionmentioning

confidence: 75%

“…The dosage of Rituximab in previous studies was between 1 and 4 doses [17, 18]. In our case, the aggressive recurrence along with the patient’s tolerance of the treatment, led us to administer 5 doses, although 3 or 4 doses may have been enough.…”

Section: Discussionmentioning

confidence: 98%

Efficacy of the Combination of Immunoadsorption and Rituximab for Treatment in a Case of Severe Focal and Segmental Glomerulosclerosis Recurrence after Renal Transplantation

2018

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Background/Aims: We present a case of a male patient with severe recurrence of focal and segmental glomerulosclerosis (FSGS) after transplant. Methods: Before the transplant he was treated with plasma exchange. Massive proteinuria was detected post-transplantation and plasma exchanges were performed without response. We administered 5 doses of Rituximab (375 mg/m²) and partial remission was achieved. Proteinuria relapse occurred 1 year post-transplant, so Immunoadsorption (IA) was started instead of plasma exchange with reduction of proteinuria. Later, 2 new episodes of proteinuria relapse were detected and treated by increasing the number of IA sessions and administering new cycles of Rituximab. After achieving partial remission, IA was reduced to one session every 7–10 days as maintenance therapy. Results: Despite the fact of the severe recurrence, renal function and proteinuria remain stable over 8 years after the transplantation was performed. Conclusion: Combination of maintenance IA and cycles of Rituximab is an effective treatment for aggressive forms of FSGS recurrence after renal transplantation.

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“…Ponticelli reported that partial or complete remission was achievable using PE or IA in 63% of adult patients [148]. Rituximab is also known to be an effective treatment for FSGS and was more effective with PE [156,157]. However, other reports have noted that rituximab showed an intermediate, or no, response [158].…”

Section: Fsgsmentioning

confidence: 99%

Histopathological findings in transplanted kidneys

et al. 2017

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Improvements in immunosuppression have reduced acute kidney allograft rejection and clinicians are now seeking ways to prolong allograft survival to 20 years and beyond. The primary cause of kidney allograft loss is still chronic rejection, followed by death with a functioning allograft and primary kidney disease recurrence. Thus, overcoming kidney allograft rejection remains the most important issue. Kidney allograft rejection can be classified into two types: T cell-and antibody-mediated rejection. Both are diagnosed pathologically based on the Banff 2013 classification. Other important pathological features in addition to rejection include calcineurin inhibitor toxicity, polyomavirus nephropathy, and recurrence of the primary kidney disease. Here, we review the diagnosis and representative features of histopathological findings in transplanted kidneys.

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Rituximab for Recurrence of Primary Focal Segmental Glomerulosclerosis After Kidney Transplantation: Clinical Outcomes

Abstract: In kidney transplantation recipients with recurrent FSGS, rituximab therapy may be a recommended treatment for cases that have failed either the initial treatment or weaning from PE.

Cited by 63 publications

References 44 publications

European Society of Pediatric Nephrology survey on current practice regarding recurrent focal segmental glomerulosclerosis after pediatric kidney transplantation

European Society of Pediatric Nephrology survey on current practice regarding recurrent focal segmental glomerulosclerosis after pediatric kidney transplantation

Efficacy of the Combination of Immunoadsorption and Rituximab for Treatment in a Case of Severe Focal and Segmental Glomerulosclerosis Recurrence after Renal Transplantation

Histopathological findings in transplanted kidneys

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